MED-EL Hear4U Loaner Program Application

The MED-EL Hear4U Loaner Program is available to support MED-EL recipients who are without sound while awaiting insurance approval for a replacement audio processor.

You are eligible to apply for this program if you meet the following requirements:

  • You have active health insurance that covers hearing technology
  • You are an adult or pediatric MED-EL cochlear implant recipient
  • You are OFF-AIR on at least one ear/side
  • You do not have a working backup device
  • Your equipment is no longer covered under warranty or service contract and you are awaiting insurance approval for a replacement device
  • Your clinic is able to provide the documentation required by insurance and audio processor maps to support your request
  • You are a current US resident.


If you are eligible based on the criteria above, follow the next steps to apply for loaner equipment.  Your application cannot be processed until all three forms have been submitted. If you need assistance, please contact customerservice.us@medel.com.

1


Complete the Patient Intake Form

We need your most up-to-date information to submit your insurance claim. Please complete and submit the Patient Intake Form by clicking this link.

2

Sign the MED-EL Hear4U Loaner Program Contract

Once your insurance benefits are verified based on your Patient Intake Form, you will be notified if you qualify for the Program.  To avoid delays in receiving your loaner equipment, please click here to view and sign the Loaner Program Contract.

3


Fill Out the Application Below

Please complete the form below with your audiologist’s name, information about the lost/non-working audio processor, and the new model you will select for your replacement/upgrade pending insurance approval. 

Recipient Information

Clinic Information

Tell us about your off-air audio processor.

The Loaner Program provides the primary components needed to get you back “on the air” while your insurance claim is in process. Additional components and accessories are available for purchase, if desired.

My audio processor is:

SONNET 2

SONNET 2
Cochlear Implant
Audio Processor

RONDO 3

RONDO 3
Cochlear Implant
Audio Processor

SONNET

SONNET
Cochlear Implant
Audio Processor

RONDO 2

RONDO 2
Cochlear Implant
Audio Processor

Select the ear for which you are requesting a loaner audio processor. Bilateral recipients: Note that only one ear is eligible for a loaner device through the Hear4U Loaner Program.

If you need any the following SONNET series components as part of the equipment loan because yours are lost or not working, check the appropriate box(es) below.

If you need any of the following RONDO series components as part of the equipment loan because yours are lost or not working, check the appropriate box(es) below.

Upgrade Device Information

Tell us which audio processor model you are selecting for your replacement or upgrade (pending insurance approval).

Please complete the order form with your final audio processor selection (including color, power options and accessories, if applicable) and return it to customerservice.us@medel.com as soon as possible.

 

If you would like to consult with a MED-EL specialist prior to making your final audio processor selection, click this link to schedule a one-on-one virtual session.

I understand that the Patient Intake Form must be completed and submitted to MED-EL for processing of my Loaner Program application.